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WARNING It is a criminal violation to make false statements on vital records application forms or to fraudulently obtain a birth certificate. Punishment may include a civil penalty of up to $5,000.00 and up to five years in prison. Utah Code, Sections 26-23-5, 26-23-5.5 and 26-23-6.

NOTE This is an online application only. Please do not print this page and mail it to our office. If you would prefer to mail an application, please click here.

* Indicates a required field
  Certificate Holder Information
  Name on Certificate
*Date of Birth
(mm / dd / yyyy)
*City of Birth
*County of Birth
*Still Living
Name of Father
Name of Mother

Applicant Information

NOTE Applicant must use his or her own credit card and the certificate will be mailed to the credit card billing address.

Your Name
Enter your name exactly as it appears on your credit card.
*Home Phone
Please include area code.
Work Phone
E-mail Address
  Credit Card Billing Address
Certificate(s) will be mailed to this address.
  Leave State blank if mailing address is not in United States or Canada.  Country will be entered on credit card information page.
*Zip/Postal Code
Your Relationship to the Certificate Holder

NOTE Only members of the immediate family are eligible to receive a copy of a birth certificate.  This includes; spouse, child, parent, legal guardian or designated legal representative, sibling, grandchild, (maternal) grandparent or (paternal) grandparent if the father is listed on the birth certificate.

*Your relationship to the certificate holder
If Other, please specify
*Reason for requesting certificate

The $20 search fee includes a certified copy of the birth certificate.  If you would like to order any additional copies of this birth certificate at this time, please specify the quantity:

Additional certified copies
x $8.00 each

Total Due